Inhaler Technique

I'm not sure it's going to be possible to answer this question in words as it probably needs a demonstration, but any ideas/reassurance would be good, and next time I'm at the surgery I'll ask then, just to be sure.

I've been using inhalers for what seems like forever, I've repeatedly had my inhaler technique checked by asthma nurses, pharmacists, GP and consultant and they've all said it's very good. In fact, even if it weren't perfect, it probably wouldn't be too much of a problem as I take all my regular inhalers through a spacer, so this only applies to my ventolin (which when my asthma's really bad I'll also take through a spacer).

Today when I went to the pharmacy to collect my giant bag of repeats (!!!) they asked to do a medicines review, which is fine, always good to check on these. During this, the pharmacist checked my inhaler technique with something I can only describe as a reverse peak flow meter - I don't know what it's called and I've never seen one before. Anyway, using this, she said I was breathing in far too deeply and so the medicine would be hitting the back of my throat and not going to my lungs. She used the meter to show me how hard to breath in, and what was required according to this was a much slower shallower breath than even normal breathing - something that I found very difficult to do and difficult to control.

My question is this - if she and her meter are correct, how does the medicine get into the lungs? Also, I've checked all the leaflets with my inhalers and they say to breath in steadily and deeply (which is what I have always done and what consultant, GP etc have always said is good) which is definitely not what I was being told to do by the pharmacist.

So... do I change my technique or just ignore her, and do I need to bother my asthma nurse about this. I can't understand how if I've been doing it so wrong for so long no one has said anything and the treatment has helped my asthma - if I'd been doing it wrong, surely it wouldn't help???

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Ooh, is a tough one, and it's all new to me. I had an inhaler technique check as part of my first asthma review with the asthma nurse. She showed me to breathe slowly and deeply, but to be honest that doesn't seem to work for me. If I do that it doesn't seem to go into my airway, but hits my tongie and the back of my throat. The only way I can get it to go into my airway is take a fast intake of breath as I press the cannister down, then kind of slow my breath down to draw it into my lungs, much like I guess a smoker would inhale smoke.

That's what seems to work for me.

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Hi Ratty,

The reverse peak flow meter was probably an inspiratory flow meter.

It is a tough one though as like Kitander I found breathing in too slowly doesn't seem to work very well. The AeroChamber and Able Spacers have training whistles that sound when you breathe in too quickly (I think this happens when the rate is >=30l/min), and I probably use roughly the same speed when using inhalers on their own. I timed myself earlier and the breathing in bit took 3.6 seconds (includes reaction time for stopwatch). I'm not sure if that's too fast or slow, so guess it's best to ask your doctor or nurse before changing if things have been okay up to now.

Not sure if that's helpful,

Ginny

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Thanks Kitanda and Ginny I forgot about the training whistle on the aerochamber, since getting the hang of it I haven't set it off at all, so I can't be inhaling that hard. I'm not too worried as I say because I'm obviously getting the meds as they make a difference and if my technique was that bad it would have been picked up before.

I tried the really slow breathing in today when taking my ventolin before exercise (I thought that was the best time to try as there were no immediate implications if it was wrong) and just ended up with a not very nice tasting mouthful of inhalant so I'll stick to my method for now and ask the GP next week as I'm going anyway.

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Funnily enough Prof Durham checked my symbicort turbohaler technique on a ward round, I am never good at public displays but to oblige I ""did one"" and he said excellant. Apparently you need to inhale it steadily rather than ""snatch"" it in a quick big inhale as if you do it too hard and fast it simply hits the back of the throat and goes no-where. Looks like preventer technique could be the flavour of the month with medical proffesionals so watch out!